Fat soluble vitamins- Vitamin A, D, E and K

Vitamins are organic compounds that are essential for normal growth and metabolism. They cannot be synthesized by the body and must be obtained from the diet or supplements. Vitamins are classified into two groups based on their solubility in water: water soluble and fat soluble.

Water soluble vitamins include vitamin C and the B complex vitamins. They dissolve in water and are easily absorbed and excreted by the body. They are not stored in significant amounts and need to be consumed regularly.

Fat soluble vitamins include vitamin A, D, E and K. They dissolve in fat and are absorbed along with dietary lipids. They are stored in the liver and adipose tissue and can accumulate to toxic levels if consumed in excess. They play important roles in various physiological functions such as vision, bone health, blood clotting and antioxidant defense.

In this article, we will discuss the solubility, sources, functions and deficiencies of fat soluble vitamins. We will also highlight the symptoms and treatment of vitamin toxicity, which can occur when fat soluble vitamins are taken in excess or when there is impaired fat absorption.

Solubility of fat soluble vitamins

Fat soluble vitamins are those that dissolve in fat and can be stored in the body`s fatty tissues. Unlike water soluble vitamins, which are excreted in urine and need to be replenished regularly, fat soluble vitamins can accumulate in the body and cause toxicity if taken in excess.

The solubility of fat soluble vitamins depends on the presence of bile salts and dietary fat in the intestine. Bile salts are produced by the liver and stored in the gallbladder. They help emulsify fat and form micelles, which are small droplets of fat that can be absorbed by the intestinal cells. Dietary fat provides a source of fatty acids and triglycerides that can combine with fat soluble vitamins and form chylomicrons, which are large lipoprotein particles that transport fat soluble vitamins from the intestine to the bloodstream.

The absorption of fat soluble vitamins is influenced by several factors, such as the amount and type of dietary fat, the integrity of the intestinal mucosa, the activity of pancreatic enzymes, and the presence of other nutrients. For example, vitamin A absorption is enhanced by dietary protein and zinc, while vitamin E absorption is reduced by iron and vitamin K. Some diseases and conditions that impair fat digestion or absorption can also affect the solubility of fat soluble vitamins. These include cystic fibrosis, celiac disease, Crohn`s disease, pancreatic insufficiency, cholestatic liver disease, bariatric surgery, and malnutrition.

The solubility of fat soluble vitamins also determines their distribution and storage in the body. Fat soluble vitamins tend to accumulate in adipose tissue, liver, and other organs that have a high lipid content. They can also cross cell membranes and enter intracellular compartments. For example, vitamin A can be stored in the liver as retinyl esters or transported to other tissues as retinol-binding protein. Vitamin D can be converted to its active form by the kidneys or other cells that have vitamin D receptors. Vitamin E can be incorporated into cell membranes or lipoproteins as an antioxidant. Vitamin K can be recycled by a vitamin K cycle that involves carboxylation and epoxidation reactions.

The solubility of fat soluble vitamins has important implications for their functions and deficiencies. Fat soluble vitamins are essential for many biological processes, such as vision, bone health, blood clotting, antioxidant defense, and gene expression. However, they can also cause adverse effects if taken in excess or if their metabolism is disrupted. Therefore, it is important to consume a balanced diet that provides adequate amounts of fat soluble vitamins without exceeding the recommended dietary allowances.

Fat soluble vitamins are most abundant in high fat foods and are much better absorbed into your bloodstream when you eat them with fat. They are also present in some fruits and vegetables that contain carotenoids, which are provitamin A compounds that can be converted into vitamin A in the body.

The main dietary sources of fat soluble vitamins are:

• Vitamin A: animal-sourced foods such as liver, fish liver oil, butter, cheese, milk, and other dairy products. Plant-sourced foods such as carrots, sweet potatoes, spinach, kale, and other leafy green vegetables that are rich in beta-carotene .
• Vitamin D: animal-sourced foods such as fatty fish (salmon, tuna, mackerel), fish liver oil, egg yolks, and fortified milk and cereals. Sunlight exposure also stimulates the production of vitamin D in the skin .
• Vitamin E: plant-sourced foods such as vegetable oils (sunflower, safflower, soybean), nuts (almonds, peanuts, hazelnuts), seeds (sunflower, pumpkin), and fortified cereals. Leafy green vegetables such as spinach and broccoli also contain some vitamin E .
• Vitamin K: plant-sourced foods such as leafy green vegetables (spinach, kale, cabbage, broccoli), Brussels sprouts, cauliflower, and soybeans. Animal-sourced foods such as liver, eggs, and cheese also provide some vitamin K .

It is important to eat a balanced diet that includes a variety of foods from different food groups to ensure adequate intake of fat soluble vitamins. However, some people may need or choose to take supplements that provide extra vitamins for various reasons. If you are considering taking supplements, consult your doctor or a registered dietitian first to determine the appropriate dosage and avoid potential interactions or side effects.

Fat soluble vitamins are essential nutrients that play important roles in various physiological processes in the body. Unlike water soluble vitamins, which are excreted in the urine and need to be replenished regularly, fat soluble vitamins are stored in the liver and adipose tissue and can accumulate to toxic levels if consumed in excess. The main functions of fat soluble vitamins are:

• Vitamin A: Vitamin A is involved in vision, cell growth and differentiation, immunity, and antioxidant activity. It has several derivatives that perform different functions in the body. For example, 11-cis-retinol is a component of rhodopsin, the light-sensitive pigment in the retina. Retinoic acid regulates gene expression and influences embryonic development, epithelial maintenance, and wound healing. Beta-carotene, a precursor of vitamin A, acts as an antioxidant and protects cells from oxidative damage.

• Vitamin D: Vitamin D is involved in calcium and phosphorus homeostasis, bone health, and immune modulation. It can be synthesized in the skin from exposure to sunlight or obtained from dietary sources. Vitamin D undergoes two hydroxylation reactions in the liver and kidney to form its active form, calcitriol. Calcitriol increases intestinal absorption of calcium and phosphorus, stimulates osteoblast activity and bone resorption, and enhances renal reabsorption of calcium. Calcitriol also regulates the expression of genes involved in cell differentiation, proliferation, and apoptosis.

• Vitamin E: Vitamin E is a collective term for a group of compounds called tocopherols and tocotrienols, which have antioxidant properties. Vitamin E protects cell membranes from lipid peroxidation by scavenging free radicals and inhibiting the propagation of oxidative chain reactions. Vitamin E also modulates immune function, platelet aggregation, inflammation, and gene expression.

• Vitamin K: Vitamin K is a cofactor for the enzyme gamma-glutamyl carboxylase, which catalyzes the post-translational modification of glutamate residues on certain proteins to form gamma-carboxyglutamate (Gla). Gla residues confer calcium-binding ability to these proteins, which are involved in blood coagulation, bone metabolism, and vascular health. The main vitamin K-dependent proteins are the clotting factors II (prothrombin), VII, IX, and X, as well as protein C, protein S, osteocalcin, and matrix Gla protein.

These are some of the major functions of fat soluble vitamins in the body. However, these vitamins also interact with each other and with other nutrients to influence various metabolic pathways and physiological outcomes. Therefore, it is important to maintain a balanced intake of fat soluble vitamins from dietary sources or supplements to ensure optimal health and prevent deficiency or toxicity.

Vitamin A is a fat-soluble vitamin that exists in different forms, such as retinol, retinal, retinoic acid, and beta-carotene. Vitamin A can be obtained from animal sources (such as liver, eggs, dairy products, and fish oil) or plant sources (such as carrots, leafy greens, sweet potatoes, and other fruits and vegetables that are rich in beta-carotene). Beta-carotene is a precursor of vitamin A that can be converted into active forms in the body.

Vitamin A has several important functions in the body, such as:

• Synthesis of rhodopsin: Rhodopsin is a visual pigment that is found in the rod cells of the retina. It enables vision in low-light conditions by absorbing light and triggering nerve impulses to the brain. Vitamin A is essential for the production of 11-cis-retinol, which is the form of vitamin A that binds to opsin (a protein) to form rhodopsin. Without enough vitamin A, rhodopsin synthesis is impaired and night blindness can result.
• Cell differentiation and growth: Vitamin A regulates the expression of genes that are involved in the development and differentiation of various types of cells, such as epithelial cells, immune cells, blood cells, and embryonic cells. Vitamin A also promotes normal growth and reproduction by stimulating cell division and differentiation. Vitamin A deficiency can lead to impaired development of organs and tissues, such as the skin, eyes, lungs, and reproductive system.
• Antioxidant: Vitamin A has antioxidant properties that help protect the body from oxidative stress and free radical damage. Oxidative stress can cause cellular damage and inflammation that can contribute to chronic diseases, such as cancer, cardiovascular disease, and neurodegenerative disorders. Beta-carotene, a precursor of vitamin A, is especially effective as an antioxidant because it can scavenge free radicals and quench singlet oxygen. Vitamin A deficiency can increase the susceptibility to oxidative stress and inflammation.

Vitamin A is a vital nutrient for maintaining good health and preventing various diseases. However, too much or too little vitamin A can also have adverse effects on the body. Therefore, it is important to consume vitamin A in adequate amounts from a balanced diet or supplements if needed.

Vitamin A deficiency is a condition that occurs when the body does not get enough vitamin A from the diet or when the body cannot absorb or use vitamin A properly. Vitamin A deficiency can have serious consequences for health, especially for the eyes, skin, and immune system.

Some of the common causes of vitamin A deficiency are:

• Fat malabsorption syndromes: These are disorders that affect the digestion and absorption of fat in the intestine, such as pancreatic insufficiency, cholestatic liver disease, celiac sprue, inflammatory bowel disease, and gastrectomy. Fat is needed to absorb vitamin A and other fat-soluble vitamins from food.
• Mineral oil laxative abuse: Mineral oil is a type of laxative that can interfere with the absorption of fat-soluble vitamins, including vitamin A. Excessive or prolonged use of mineral oil can lead to vitamin A deficiency.
• Malnutrition: This is a condition that results from inadequate intake of nutrients, including vitamin A. Malnutrition can be caused by poverty, famine, food insecurity, eating disorders, or other factors that limit access to or availability of nutritious food.

Some of the common symptoms of vitamin A deficiency are:

• Night blindness: This is a condition that affects the ability to see in dim light or darkness. It is caused by a lack of rhodopsin, a visual pigment that is made from vitamin A and helps the eyes adapt to low-light conditions. Night blindness can impair daily activities such as driving, reading, or walking at night.
• Poor wound healing: This is a condition that affects the speed and quality of tissue repair after an injury or infection. It is caused by a lack of retinoic acid, a form of vitamin A that regulates cell growth and differentiation. Poor wound healing can increase the risk of infection and scarring.
• Increased susceptibility to infection: This is a condition that affects the ability to fight off pathogens and diseases. It is caused by a lack of vitamin A and its derivatives, which play an important role in maintaining the integrity and function of mucous membranes, skin, and immune cells. Increased susceptibility to infection can lead to frequent or severe illnesses such as respiratory infections, diarrhea, measles, or tuberculosis.
• Bitot spots: These are white patches on the conjunctiva, the thin membrane that covers the white part of the eye. They are caused by a buildup of keratin, a protein that normally forms part of the skin and hair. Bitot spots are a sign of chronic vitamin A deficiency and can impair vision if left untreated.
• Hyperkeratinization and resulting skin dryness: This is a condition that affects the texture and appearance of the skin. It is caused by an excess production of keratin, which makes the skin rough, dry, scaly, and prone to cracking. Hyperkeratinization can also affect other parts of the body such as the hair and nails.
• Ulceration and keratinization of the cornea: This is a condition that affects the transparency and function of the cornea, the clear layer that covers the front part of the eye. It is caused by a lack of vitamin A and its derivatives, which are essential for maintaining the health and regeneration of corneal cells. Ulceration and keratinization of the cornea can lead to pain, inflammation, infection, scarring, and blindness.
• Complete blindness: This is a condition that results from irreversible damage to the retina, the light-sensitive layer at the back of the eye. It is caused by prolonged or severe vitamin A deficiency, which can destroy the photoreceptor cells that convert light into nerve signals. Complete blindness can severely affect one`s quality of life and independence.

Vitamin A deficiency can be prevented by consuming foods rich in vitamin A or its precursors such as carrots, leafy greens (eg, spinach), sweet potato, liver, eggs, dairy products, and fortified foods. Vitamin A supplements may also be recommended for people who are at risk of deficiency due to certain medical conditions or dietary restrictions.

Vitamin A deficiency can be treated by administering high doses of vitamin A under medical supervision. The dosage and duration of treatment depend on the severity and cause of deficiency. Early signs of deficiency can often be reversed with supplementation, but late signs may be irreversible or require additional interventions such as surgery or eye drops.

Vitamin A deficiency is a serious public health problem that affects millions of people worldwide, especially children in developing countries. According to the World Health Organization (WHO), vitamin A deficiency is responsible for about 250 000 to 500 000 cases of childhood blindness every year. Vitamin A deficiency also increases the risk of mortality from common infections such as measles and diarrhea. Therefore, it is important to recognize and address vitamin A deficiency as soon as possible to prevent its devastating consequences.

Vitamin A toxicity occurs when the intake of vitamin A exceeds the body`s storage capacity and causes high levels of vitamin A in the blood. This can happen with either acute or chronic ingestion of large doses of vitamin A or its derivatives, such as retinoids.

Acute vitamin A toxicity is rare and usually results from accidental ingestion of vitamin A supplements by children or intentional overdose by adults. Symptoms may include nausea, vomiting, headache, drowsiness, blurred vision, irritability, and increased intracranial pressure. In severe cases, acute vitamin A toxicity can cause liver damage, hemorrhage, coma, and death.

Chronic vitamin A toxicity is more common and usually results from long-term consumption of more than 50 000 IU per day of vitamin A for longer than 3 months. Symptoms may include dry and scaly skin, hair loss, cracked lips, bone and joint pain, loss of appetite, weight loss, headache, and hepatosplenomegaly. Chronic vitamin A toxicity can also cause birth defects in pregnant women and increased risk of fractures in older adults.

The treatment of vitamin A toxicity depends on the severity and duration of exposure. Mild cases may be managed by discontinuing the intake of vitamin A and monitoring the symptoms. Severe cases may require hospitalization and supportive care, such as intravenous fluids, antiemetics, steroids, and liver transplantation.

The prevention of vitamin A toxicity involves following the recommended dietary allowances (RDA) for vitamin A intake. The RDA for adults is 900 mcg (3000 IU) for men and 700 mcg (2333 IU) for women. The upper limit (UL) for adults is 3000 mcg (10 000 IU) per day. The RDA and UL for children vary according to age and weight. Pregnant and breastfeeding women should consult their health care providers before taking any vitamin A supplements.

Vitamin A toxicity is a serious condition that can have detrimental effects on health. Therefore, it is important to consume vitamin A in moderation and avoid excessive supplementation. Vitamin A is essential for many functions in the body, but too much of it can be harmful.

Vitamin D is a fat-soluble vitamin that has two main forms: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Vitamin D2 is found in some plant foods, while vitamin D3 is synthesized in the skin when exposed to sunlight or obtained from animal foods. Both forms are converted into active metabolites in the liver and kidneys that regulate calcium and phosphorus metabolism and bone health .

Sources of Vitamin D

The main source of vitamin D for most people is sunlight. Ultraviolet B (UVB) rays from the sun trigger the conversion of cholesterol in the skin into cholecalciferol, which is then transported to the liver and kidneys for further processing . The amount of vitamin D produced by sunlight depends on several factors, such as the time of day, season, latitude, skin pigmentation, sunscreen use, and clothing.

Some foods also provide vitamin D, either naturally or through fortification. The following table lists some common food sources of vitamin D and their approximate amounts :

The recommended dietary allowance (RDA) for vitamin D is 600 IU (15 mcg) per day for adults up to age 70 and 800 IU (20 mcg) per day for adults over 70. However, some experts suggest that higher intakes may be needed for optimal health and disease prevention.

Functions of Vitamin D

Vitamin D plays a crucial role in maintaining normal blood levels of calcium and phosphorus, which are essential for bone mineralization and growth. Vitamin D enhances the absorption of calcium and phosphorus from the intestine and promotes their reabsorption from the kidney. Vitamin D also works with parathyroid hormone (PTH) to stimulate osteoclasts, which are cells that break down bone tissue and release calcium into the blood .

By regulating calcium and phosphorus metabolism and bone health, vitamin D helps prevent rickets in children and osteomalacia in adults, which are conditions characterized by softening and weakening of bones due to inadequate mineralization. Vitamin D may also help prevent osteoporosis, which is a condition of reduced bone density and increased fracture risk due to aging or other factors .

In addition to its role in bone health, vitamin D has other functions in the body that are still being explored. Some of these include:

• Modulating immune system function and inflammation
• Regulating cell growth and differentiation
• Influencing insulin secretion and glucose metabolism
• Affecting mood and cognitive function
• Protecting against certain cancers and cardiovascular diseases

Vitamin D deficiency can result from inadequate exposure to sunlight, low dietary intake, malabsorption disorders, liver or kidney diseases, or genetic variations that affect vitamin D metabolism. Vitamin D deficiency can cause rickets in children and osteomalacia in adults, as well as increase the risk of infections, autoimmune diseases, diabetes, depression, and some cancers .

Vitamin D toxicity can occur from excessive supplementation or intake of vitamin D-fortified foods. Vitamin D toxicity can cause hypercalcemia, which is a condition of abnormally high blood calcium levels that can damage the kidneys, heart, blood vessels, and soft tissues. Symptoms of vitamin D toxicity include nausea, vomiting, constipation, weakness, confusion, arrhythmias, and kidney stones .

Vitamin D is an important nutrient for bone health and other aspects of human health. It can be obtained from sunlight exposure or food sources. However, both deficiency and toxicity of vitamin D can have serious consequences for health. Therefore, it is advisable to consult a doctor before taking any vitamin D supplements or changing your diet.

Vitamin D toxicity, also known as hypervitaminosis D, is a rare but potentially serious condition that occurs when you have excessive amounts of vitamin D in your body. Vitamin D toxicity is usually caused by large doses of vitamin D supplements — not by diet or sun exposure.

The main consequence of vitamin D toxicity is a buildup of calcium in your blood (hypercalcemia), which can cause nausea and vomiting, weakness, and frequent urination. Vitamin D toxicity might progress to bone pain and kidney problems, such as the formation of calcium stones .

Vitamin D toxicity can also be seen in sarcoidosis, in which abnormal cells convert vitamin D into active metabolites.

The normal range for blood concentration of vitamin D is 20 to 50 nanograms per milliliter (ng/mL). However, the toxic state is known to be a value of 100 ng/ml or more in a clinical setting.

The dose of vitamin D you need to take to produce toxic signs and symptoms varies greatly. It can occur with as little as 2,000 international units per day (IU/d) in susceptible people. The maximum suggested daily requirement is 4,000 IU/d for healthy adults.

To prevent vitamin D toxicity, you should follow the recommendations of your healthcare provider if you are taking vitamin D supplements or prescription medications. You should also avoid taking more than one product that contains vitamin D at the same time.

If you experience any symptoms of vitamin D toxicity, such as nausea, vomiting, weakness, frequent urination, or bone pain, you should seek medical attention immediately. Vitamin D toxicity can be treated by stopping the intake of vitamin D supplements or medications and by lowering the calcium levels in your blood with fluids, diuretics, or medications .

Vitamin E is a fat-soluble vitamin that is found in various foods, such as cereals, almonds, vegetable oils, and green leafy vegetables. It is also available as a dietary supplement.

Vitamin E has several important functions in the body, but the most well-known one is its role as an antioxidant. Antioxidants are substances that protect the cells from damage caused by free radicals, which are unstable molecules that can harm the DNA, proteins, and membranes of the cells. Free radicals are generated by normal metabolic processes, such as energy production and immune response, but also by external factors, such as pollution, smoking, and radiation. By scavenging free radicals, vitamin E helps to prevent or reduce oxidative stress, which is associated with aging and various chronic diseases, such as cardiovascular disease, cancer, diabetes, and neurodegenerative disorders.

Another function of vitamin E is to modulate the immune system. Vitamin E can enhance the activity of certain immune cells, such as T cells and natural killer cells, which are involved in fighting infections and tumors. Vitamin E can also suppress the production of inflammatory cytokines, which are molecules that trigger inflammation and tissue damage in response to infection or injury. By regulating the immune response, vitamin E can help to maintain a balance between immunity and inflammation, which is essential for health and disease prevention.

A third function of vitamin E is to support the nervous system. Vitamin E can protect the neurons from oxidative damage and maintain their membrane integrity and function. Vitamin E can also modulate the expression of genes that are involved in neuronal development and survival. Moreover, vitamin E can influence the synthesis and release of neurotransmitters, which are chemical messengers that enable communication between neurons. By affecting the nervous system, vitamin E can influence cognitive functions, such as memory and learning, as well as mood and behavior.

In summary, vitamin E is a fat-soluble vitamin that has multiple functions in the body, mainly as an antioxidant, an immune modulator, and a neuroprotective agent. Vitamin E can be obtained from various food sources or supplements. However, excessive intake of vitamin E can have adverse effects on health and should be avoided. The recommended dietary allowance (RDA) for vitamin E for adults is 15 mg per day.

Vitamin E deficiency is rare and usually occurs due to an underlying condition that affects the absorption or metabolism of fat, such as:

• Fat malabsorption syndromes (e.g., cystic fibrosis, celiac disease, Crohn`s disease)
• Abetalipoproteinemia (a genetic disorder that prevents the formation of lipoproteins)
• Cholestatic liver disease (a condition that impairs the flow of bile from the liver)
• Chronic renal failure (a condition that reduces the kidney function)

Vitamin E deficiency can also result from inadequate dietary intake, especially in premature infants and people with very low-fat diets.

The symptoms of vitamin E deficiency are mainly related to the damage of nerve and muscle cells caused by oxidative stress. These include:

• Muscle weakness and pain
• Coordination and walking difficulties
• Numbness and tingling in the arms and legs (paresthesia)
• Vision problems and eye damage
• Impaired immune system and increased susceptibility to infections
• Hemolytic anemia (a condition that causes the breakdown of red blood cells)

Vitamin E deficiency can be diagnosed by measuring the blood levels of alpha-tocopherol, the main form of vitamin E in the body. A level below 4 mg/L is considered deficient. The treatment involves vitamin E supplementation, either orally or by injection, depending on the severity of the deficiency and the underlying cause. The dosage and duration of treatment may vary depending on the individual`s needs and response.

Vitamin E deficiency can be prevented by consuming a balanced diet that includes foods rich in vitamin E, such as:

• Nuts and seeds (e.g., almonds, sunflower seeds, peanuts)
• Vegetable oils (e.g., olive, sunflower, soybean)
• Whole grains (e.g., wheat germ, oatmeal, brown rice)
• Leafy green vegetables (e.g., spinach, kale, broccoli)
• Eggs
• Fortified cereals

Vitamin K deficiency is a condition in which the body does not have enough vitamin K to produce the proteins that are involved in blood clotting. This can lead to excessive bleeding both internally and externally.

Vitamin K deficiency is very rare in adults, as most people get enough vitamin K from their diet and from the bacteria that live in their intestines. However, some factors can increase the risk of vitamin K deficiency, such as:

• Taking blood thinners or antibiotics that interfere with vitamin K activation or production
• Having a medical condition that affects fat absorption, such as celiac disease, cystic fibrosis, or liver disease
• Having part of the intestine removed, such as during bariatric surgery
• Not getting enough vitamin K from food sources, such as leafy green vegetables, cabbage, or animal products

The main symptom of vitamin K deficiency is bleeding too much. This can manifest in different ways, such as:

• Bruising easily
• Getting small blood clots under the nails
• Bleeding from the nose, gums, or other mucous membranes
• Having dark or bloody stools
• Having prolonged bleeding from minor wounds or injections
• Having hemorrhages in the brain or other organs

Vitamin K deficiency can be life-threatening if not treated promptly. The treatment involves giving vitamin K supplements orally or by injection, depending on the severity of the deficiency and the cause. Vitamin K supplements can reverse the symptoms of vitamin K deficiency and restore normal blood clotting.

Vitamin K deficiency is more common in newborns, especially those who are exclusively breastfed. This is because breast milk is low in vitamin K, and newborns have low levels of vitamin K in their bodies and cannot produce it efficiently. Newborns with vitamin K deficiency can develop a serious bleeding disorder called vitamin K deficiency bleeding (VKDB), which can cause bleeding in the brain or other organs.

To prevent VKDB, newborns are usually given a single dose of vitamin K by injection shortly after birth. This provides enough vitamin K for the first few months of life until they start producing it on their own. Alternatively, oral vitamin K supplements can be given to newborns regularly for several weeks.

Vitamin K is an essential nutrient for blood clotting and bone health. To avoid vitamin K deficiency and its complications, it is important to consume adequate amounts of vitamin K from food sources or supplements, especially if you have a condition that affects vitamin K absorption or production.

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